Health care interactions with deaf culture.

Approximately 9% to 10% of Americans have hearing loss, making it the second most common disability in the United States. Regardless of hearing loss level, persons who are deaf or hard of hearing (D&HH) have altered health care utilization patterns and significant communication difficulties with physicians, often experiencing misunderstandings about their disease or treatment recommendations. They are a “silent” group to many physicians. The D&HH population is a heterogeneous group that includes persons who have varying degrees of hearing loss, use multiple languages, and belong to different cultures. Solutions to providing health care to one group from the D&HH population do not necessarily apply to the other groups. Factors that must be considered with this population include degree of hearing loss, age of onset of loss, preferred language, and psychological issues. In this article, D&HH refers to anyone with a hearing loss, ranging from hard of hearing to profoundly deaf. Persons referred to as deaf (lower case d), usually do not consider themselves members of the Deaf Community, although they may be severely or profoundly deaf. These deaf persons may prefer English as their means of communication with physicians, but their usage of English may not be standard. Persons referred to as Deaf (upper case D) typically belong to the Deaf Community, a minority population with its own culture and social mores, use American Sign Language (ASL), and typically have a low English reading level. ASL differs from English in crucial ways, including its idioms and grammar. Members of the Deaf Community usually prefer certified ASL interpreters when seeing physicians. Deaf persons are the non–English-speaking minority at greatest risk for physician-patient miscommunication. When communicating with Deaf persons, physicians should remember that they probably have low reading levels and their writing is usually nonstandard English. Two examples of the Deaf Community’s social mores that are relevant to the health care setting are: